Dietary adherence and weight loss success among overweight women: results from the A TO Z weight loss study

Background: Dietary adherence has been implicated as an important factor in the success of dieting strategies; however, studies assessing and investigating its association with weight loss success are scarce. Objective: We aimed to document the level of dietary adherence using measured diet data and to examine its association with weight loss success. Design: Secondary analysis was performed using data from 181 free-living overweight/obese women (mean +/- s.d. age 43 +/- 5 years, body mass index 31 +/- 4 kg m(-2)) participating in a 1-year randomized clinical trial (the A TO Z study) comparing popular weight loss diets (Atkins, Zone and Ornish). Participants' dietary adherence was assessed as the difference between their respective assigned diet's recommended macronutrient goals and their self-reported intake. Association between dietary adherence and 12-month weight change was computed using Spearman's correlations. Differences in baseline characteristics and macronutrient intake between the most and least adherent tertiles for diet groups were compared using t-tests. Results: Within each diet group, adherence score was significantly correlated with 12-month weight change (Atkins, r(s) = 0.42, P = 0.0003; Zone, r(s) = 0.34, P = 0.009 and Ornish, r(s) = 0.38, P = 0.004). Twelve-month weight change in the most vs least adherent tertiles, respectively, was -8.3 +/- 5.6 vs -1.9 +/- 5.8 kg, P = 0.0006 (Atkins); -3.7 +/- 6.3 vs -0.4 +/- 6.8 kg, P = 0.12 (Zone) and -6.5 +/- 6.8 vs -1.7 +/- 7.9 kg, P = 0.06 (Ornish). Conclusions: Regardless of assigned diet groups, 12-month weight change was greater in the most adherent compared to the least adherent tertiles. These results suggest that strategies to increase adherence may deserve more emphasis than the specific macronutrient composition of the weight loss diet itself in supporting successful weight loss.